白三烯受体拮抗剂孟鲁司特对儿童哮喘抗炎机制及疗效研究

Anti-inflammation mechanism and effect of leukotriene receptor antagonist Montelukast on respiratory airway in children with asthma

目的探讨白三烯受体拮抗剂孟鲁司特对儿童哮喘气道炎症的影响程度及药物应用与临床疗效关系。方法将130例6-14岁的中度哮喘儿童随机分为口服孟鲁司特5mg/d、吸入布地奈得200μg/d、吸入氟替卡松250μg/d、孟鲁司特5mg/d加吸入布地奈得200μg/d和加吸入布地奈得100μg/d共5组,持续治疗12周。于治疗开始和第12周临床评估和肺功能检查,同时检测血Fos计数及血嗜酸细胞阳离子蛋白(ECP)、白细胞介素-5(IL-5)和肿瘤坏死因子α(TNF-α)水平。结果哮喘患儿治疗后临床评分和肺功能FEV1及PEF明显改善。各组间临床疗效比较差异无显著性(X2=0.455,P>0.05)。哮喘患儿治疗前血ECP、IL-5、INF-α浓度和Eos计数均高于正常儿童对照组(P<0.01);治疗后血ECP、IL-5、TNF-α浓度和Eos计数较治疗前降低差异呈显著性,P<0.01。哮喘患儿血Eos计数与血ECP浓度显著正相关,血IL-5水平与血ECP浓度显著正相关。结论孟鲁司特能抑制炎症细胞聚集和细胞因子释放,有效抑制气道收缩,改善肺功能,控制哮喘的临床症状。

Objective To study the effect of Montelukast, leukotriene receptor antagonist, on the respiratory airway inflammation and the relationship between it＇s administration and the clinical effect of children with asthma. Methods 130 children with moderate asthma aged 6 - 14 years old were randomly assigned to five groups,group A：5 mg Montelukast orally daily,group B： 200μg Budesonide irhaled daily,group C：250μg Fluticasone inhaled daily,group D：5 mg Montelukast daily plus 200μg Budesonide inhaled daily and group E：5mg Montelukast daily plus 100μg Budesonide irhaled daily. The duration of the treatment is 12 weeks. Before starting therapy and 12 months later,clinical effects were observed, and long function were measured in patients simuhaneously. The concentrations of serum eosinophil cationic protein （ECP）, intedeukin-5 （IL-5） and tumor necrosis factor alpha （TNFα） were measured respectively;also blood eosinophil （Eos） was counted.Results Following treatmere,clinical evaluation was improved and there was significant increase in lung function FEV1 and PEF in asthmatic children. There was no significant difference among different groups,x^2 = 0.455, P 〉 0.05. There was significant in the paticnts group compared with the nomral control group of increased amounts of serum ECP, IL-5,TNT-α, and blood Eos counting, P〈 0.01 .There was significant decrease in serum ECP,IL-5, TNT-α and blood Eos counting in asthmatic children after treatment, P 〈 0.01 .The blood Eos counting was significantly correlated with ECP concentrafion in serum of patients with asthma, P 〈 0.01, the level of IL-5 was also significantly correlated with ECP concentratioas, P 〈 0.01. Conclusion Montelukast can inhibit the aggregation of inflammatory cell and the release of cytokine, inhibit the contraction of respiratory airway, improve the lung function and the asthmatic symptom.